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The Eldercare/Disability Direct Care Workforce: Invisible, Underutilized and Essential Steven L. Dawson President 9 March 2009
The Eldercare/Disability Direct Care Workforce:
Invisible, Underutilized and Essential Steven L. Dawson
President
9 March 2009
Healthcare jobs = essential to U.S. economy
LTC is essential to healthcare employment
LTC will be increasingly essential
And DCW jobs are essential to LTC
And even though losing ground
Chart1
0.3
0.16
-0.03
* Physicians and RNs.
Series 1
Changes in real wages and per capita health care spending, 1999-2007 (1999 dollars)
Sheet1
Series 1
Per capita spending on health care30%
Real wages for health professionals*16%
Real wages for home care workers-3%
To resize chart data range, drag lower right corner of range.
DC workers will be increasingly essential
DC workforcemassive yet invisibleBy 2016, there will be more direct-careworkers (4 million) than: Teachers from K through 12 (3.8 m.) Registered nurses (3.1 m.) Fast food & counter workers (3.5 m) Waiters & waitresses (2.6 m.) Cashiers (3.4 m.)
Soon to be 4,000,000 strongAlready investing $56 billion/yearProviding 8 out of every 10 hours of paid careA substantial human capital asset that is available to improve quality services
DC workersan underutilized resource
Re-write the job description for DC workersHome-care front line for chronic disease managementContinuing care workerstrained across settingsWellness and prevention educational roleLiaisons to family caregivers offering skills & supports
There is no mystery here
Collaborating for a Stronger Eldercare Workforce
Steven L. Dawson (PHI)Nancy E. Lundebjerg (AGS)Alliance Co-Conveners
Project Director: Alice H. Hedt www.eldercareworkforce.org [email protected] Workforce Alliance
Eldercare Workforce Alliance members**Alliance Co-conveners
AARPCouncil on Social Work EducationAlzheimers AssociationDirect Care AllianceAmerican Academy of NursingFamily Caregiver AllianceAmerican Association for Geriatric PsychiatryGerontological Society of AmericaAmerican Association of Homes and Services for the AgingNational Alliance for CaregivingAmerican Geriatrics Society**National Council on AgingAmerican Medical AssociationNational Hispanic Council on AgingAmerican Medical Directors AssociationNCCNHR The National Consumer Voice for Quality Long-term CareAmerican Nurses AssociationNCB Capital Impact/THE GREEN HOUSE ProjectAmerican Psychological AssociationNew York Academy of Medicine/Social Work Leadership InstituteAmerican Society of Consultant PharmacistsPHI**American Society on AgingVisiting Nurse Associations of AmericaCoalition of Geriatric Nursing Organizations
The Eldercare/Disability Direct Care Workforce:
Invisible, Underutilized and Essential Steven L. Dawson
President
*The latest 2006 employment estimate for the direct service workforce surpasses the 3 million mark and projected demand calls for an additional one million new positions by 2016.
*The latest 2006 employment estimate for the direct service workforce surpasses the 3 million mark and projected demand calls for an additional one million new positions by 2016.
*The latest 2006 employment estimate for the direct service workforce surpasses the 3 million mark and projected demand calls for an additional one million new positions by 2016.
*The latest 2006 employment estimate for the direct service workforce surpasses the 3 million mark and projected demand calls for an additional one million new positions by 2016.
*While per-person spending on health care increased 30 percent from 1999 to 2007, real wages for home care workers have declined between 3 and 4 percent. At the same time, real wages for doctors and RNs have increased approximately 16 percent.*The latest 2006 employment estimate for the direct service workforce surpasses the 3 million mark and projected demand calls for an additional one million new positions by 2016.
*Also the 6th most popular job for women in the United States
At 4 million, the size of this workforce will exceed:Registered nurses Teachers from K thru high school Fast food and counter workers waiters and waitresses cashiers
*The direct care workforce is part of the health care infrastructure that is necessary for delivery reform to succeed.
DC workforce is deployed in 100s of 1000s of homes and tens of 1000s of facilities around the country every day.It is a tremendously valuable yet underutilized asset in our health care infrastructure. Need to seek ways to leverage this resource toward our reform goals of: improving access, promoting quality, increasing efficiency, and controlling costs.
DCWs can play progressive role in reducing costs*The direct-care workforce is deployed in 100s of thousands of homes and tens of 1000s of facilities around the country every day. It is a tremendously valuable, yet underutilized, asset in our health care infrastructure. We absolutely must seek to leverage this resource toward our reform goals of: improving access, promoting quality, increasing efficiency, and controlling costs.
The direct-care workforce is ideally positioned to help monitor chronic health conditions, ensure compliance with medication and health care regimens, and introduce wellness and prevention education, thus resulting in better health status for consumers and lower medical costs for our health care system.
Telehealth (aka remote monitoring The shortage and costs of nursing staff in home care led to adoption of a variety of telehealth applications. The progressive home care agencies use LPNs to do the installation, de-installation, inventory and patient teaching. Home health aides are beginning to be trained to assist patients with the equipment. The Jewish Home and Hospital in NYC uses the Health Buddy equipment for their waiver clients and the aide is trained in the use.
Recent efforts to involve home care workers in monitoring the chronic health conditions of the individuals they are serving have great promise as a building block for new disease management practices.
(from Carol) -For lack of any better terms, there is more work occurring on the type of worker thats needed for a system of long-term care services(adult day, assisted living, nursing home, home care, chronic care management). The Catholic Health Care System in NYC (under the management and direction of the Archdiocese of New York City), in concert with 1199/SEIU has created a Labor Management Team to design the new job which would be someone who can perform the jobs in all of the settings mentioned, plus OMR DD (I think this is a reach). Anyway, the emphasis will be on people who are multi-skilled (or wish to become) and can work in an interdisciplinary team, focus on psycho-social issues, handle family member demands and conflicts, and communicate with other members of the team towards care management goals. This work is important to new long-term care models that integrate the services under a capitated payment. Genesis System in western Mass. has experimented with it for several years with some success once they figured out what kind of organizational supports were necessary to ensure success. The Catholic System plans on using mentoring and Coaching Supervision as integral to the model.
By providing a mix of education and modest incentives, direct-care workers may be able to support certain health-related behaviors, and thus certain conditions, that are acquired or exacerbated by poor eating habits, lack of physical activity, and social isolation.
Since direct-care workers themselves often come from communities where the incidence of certain chronic conditions is high, it may make sense to think of the worker and the consumer as a health dyad where resources could be focused to change behavior and improve health status of the two, together
Next Step in Care and Care Transition Intervention models Next Step in Care (www.nextstepincare.org) is a project that the United Hospital Fund in NYC has developed to assist family caregivers. We have created numerous tools that provide better information for family caregivers and are currently developing a set of tools that focus on the aide and how to work with your direct care worker regardless of whether you hire directly or go through an agency. In a similar vein, Eric Colemans work in Care Transitions and the creation of Care Transition Coaching for high risk patients offers new opportunities for us to position the aide particularly for the patient with no family caregiver. We know that home care clinical staffing leads to delays in the nursing visit once a person is discharged from a hospital or nursing home. There is talk once more of having an aide who goes with the patient when discharged, making sure that medications are gotten and taken, monitoring, etc. The Genesis System (assisted living) has used this model and NY experimented with it several years ago. We still use a personal care aide for Expedited Hospital Discharge in NY.
Wellness and prevention education: Can support preventative behaviors re: eating habits, physical activity & social connection
*Labor demand/supply situation highly problematic.
LTC system cant continue to rely on steady supply of women with few other employment opportunities.
Todays demographics are strikingly different from the labor supply conditions that existed from the 1960s to the early 1990s when increasing numbers of females were entering the labor force.
At the beginning of the current decade, the absolute size of this cohort began to contract. The old workforce paradigm viewed this workforce as largely disposable, and turnover as an unavoidable cost of doing business. But the structural supply change underway shifts the workforce calculus to a focus on retention and a consideration of the costs that turnover exacts in terms of replacement, additional training, lost productivity, and even lost revenues.
This graphic shows that at the same time that overall demand for DSWs is projected to increase by 34% over the next decade, adding one million new openings by 2016, the number of women aged 25-54 the main labor pool from which these workers are drawn is projected to increase by less than 1 percent, down from over 18 percent just two decades ago.
Wages determine competitive attractiveness of direct service work both inside & outside of LTC sector
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